Original ArticleComplications of spinal surgery for elderly patients with lumbar spinal stenosis in a super-aging country: An analysis of 8033 patients
Introduction
The Japanese Society for Spine Surgery and Related Research (JSSR) forms part of the Japanese Orthopaedic Association (JOA) and comprises 3611 spine surgeons and researchers. The society performed three studies on the complications in spinal surgery in 1994, 2001, and 2011 [1], [2], [3], [4]. The results of the 2011 study as a whole [4] and another study comparing results among the 3 surveys [5] have been reported elsewhere, but detailed results regarding particular diseases have yet to be described.
Japan was the most aging society of the developed nations in 2010 [6]. As of the end of 2010, 23.1% of the Japanese population was aged >65 years, and 6.5% was aged >80 years.
Lumbar spinal stenosis (LSS) is a particularly common medical condition affecting the elderly, and the number of surgeries for this condition is increasing worldwide [7], [8]. Many surveys have identified this as the most popular spinal surgery [5], [9], [10]. Surgery for elderly patients with back and leg problems is aimed at maintaining activity in daily life as opposed to allowing them to become bedridden [11], but is also related to various risks threatening patient life.
Information regarding surgical treatment and complications performed on elderly patients with LSS in Japan may be useful for spine surgeons in other countries as their populations undergo similar aging. The purpose of this study was thus to present information about surgery and complications obtained from a large number of elderly patients with LSS from an aging society, and to compare patients aged ≥80 years to those aged 65–79 years (1620 and 6413 patients each).
Section snippets
Data collection
Data for this study were obtained from the study performed by the JSSR during the 1-year period from January 1 to December 31, 2011. The JSSR project team prepared two computerized questionnaires to capture both clinicopathological information (173 items) and surgical information (117 items). A recordable optical disc for data storage was sent by JSSR in January 2012 to all 1105 spine surgeons certified by the JSSR in order to collect surgical data. This data was returned by the end of May
Results
The certified surgeons were distributed among 750 institutions nationwide. Responses were obtained from 209 institutions (response rate, 28%). The total number of patients in the 2011 study was 31,380 [4], [5]. After excluding those cases that lacked principal information, data from 8033 patients aged ≥65 years were examined. These comprised 4302 men and 3731 women, with a mean age of 74.6 years (65–69 years: n = 1696; 70–79 years: n = 4717; 80–89 years: n = 1587; and ≥90 years: n = 33).
Discussion
There is no paper that analyzed so many patients aged ≥80 years with regard to surgical and general complications.
Nanjo et al. reported that the surgical outcome and the incidence of postoperation complications of decompression surgery for LSS without degenerative scoliosis of more than 10°, more than 3 mm spondylolisthesis or over 10° instability were similar between patients aged ≥80 and <80 years [12]. In this study, the incidence of surgical complications did not differ significantly
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgments
We are very grateful to doctors from the 209 participating institutions for their kind and generous cooperation with this study on spine surgery.
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